LMPA - Integrated Registration Form

Loddon Mallee Preschool Association

Central Enrolments for Funded Kindergarten
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Child's Details
Child's Name*

First NameLast Name
MaleFemaleUnspecified
Child's Date of Birth*

DayMonthYear
Please attach confirmation of your child’s date of birth*

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Child's Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Both parentsParent / Guardian 1Parent / Guardian 2Formal Kinship CareFoster CarePermanent CareResidential CareInformal Kinship Care
Parent's Details
Parent / Guardian 1*

First NameLast Name
Relationship to the child*
Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number*
Mobile preferred
Email*
Please Note: You will be notified of all correspondence via email
Primary language spoken at home*
YesNo
YesNo
Health Care Card Number*
Health Care Expiry Date*

DayMonthYear
Please attach a copy of your Health Care card*

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YesNo
Pensioner Concession Card Number*
CRN Number
Pensioner Card Expiry Date*

DayMonthYear
Please attach a copy of your Pensioner Concession card*

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YesNo
DVA Card Number*
Department of Veterans Affairs Expiry Date*

DayMonthYear
Please attach a copy of your Department of Veterans Affairs card*

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NDIS reference number*
Please attach a copy of the assessment or letter*

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Please provide further details*

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Please attach a copy of the assessment or letter*

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Kindergarten Funding Questions

Please note: the collection of this information is a requirement of the Victorian Government as part of the Early Childhood Reform Plan.

Occupation Group: More details

Please select the appropriate parental occupation group from the drop down menu. For more comprehensive details please refer here.
- If the person is not currently in paid work but has had a job in the last 12 months, or has retired in the last 12 months, please use their last occupation to select from the occupation groups
- If the person has not been in paid work for the last 12 months, select "N"
What is the highest year of primary / secondary school that Parent / Guardian 1 has completed?*
What is the level of the highest qualification that Parent / Guardian 1 has completed?*
What is the occupation of Parent/Guardian 1?*
What is the occupation group of Parent / Guardian 1?*
YesNo
Parent / Guardian 2*

First NameLast Name
Relationship to the child*
Same as parent / guardian 1Different to parent / guardian 1
Residential Address*

Street Address

Street Address Line 2

SuburbState

Post Code
Phone Number*
Mobile preferred
Email*
Please Note: You will be notified of all correspondence via email
YesNo
Health Care Card Number*
Health Care Expiry Date*

DayMonthYear
Please attach a copy of your Health Care card*

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YesNo
Pensioner Concession Card Number*
CRN Number
Pensioner Card Expiry Date*

DayMonthYear
Please attach a copy of your Pensioner Concession card*

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YesNo
DVA Card Number*
Department of Veterans Affairs Expiry Date*

DayMonthYear
Please attach a copy of your Department of Veterans Affairs card*

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YesNo
NDIS reference number*
Please attach a copy of the assessment or letter*

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YesNo
Please provide further details*

0/230
Please attach a copy of the assessment or letter*

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What is the highest year of primary / secondary school that Parent / Guardian 2 has completed?*
What is the level of the highest qualification that Parent / Guardian 2 has completed?*
What is the occupation of Parent / Guardian 2?*
What is the occupation group of Parent / Guardian 2?*
Additional information about your child
By completing the following information, you will help our team support your family. This information will also be used to access priority of access for a kindergarten placement and access to additional hours for priority cohorts (as defined by the Department of Education)
NoTorres Strait IslanderAboriginalBoth Aboriginal and Torres Strait Islander
Refugee visa (subclass 200)In-country Special Humanitarian visa (subclass 201)Global Special Humanitarian visa (subclass 202)Emergency Rescue visa (subclass 203)Woman at risk visa (subclass 204)Humanitarian Stay visa (subclass 449)Temporary Protection visa (subclass 785)Temporary Humanitarian Concern visa (subclass 786)Safe Haven Enterprise visa (subclass 790)Protection visa (subclass 866)Bridging visa A-E for humanitarian or refugee visaCurrent or expired ImmiCard
Please attach a copy of your visa

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YesNo
Health Care Number*
Health Care expiry date*

DayMonthYear
Please attach a copy of the Health Care card*

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Please note: The eligibility of concessions may vary from time-to-time. Up-to-date information can be found here.
YesNo
YesNo
Child eligible or undergoing assessment for a disability under the NDISChild eligible for Early Childhood Intervention Service Continuity of SupportChild diagnosed with a disability or developmental delay or undergoing diagnosisChild with developmental concerns that presents barriers to accessing a kindergarten programChild has complex medical needs that presents barriers to accessing a kindergarten programChild holds Disability Health Care CardChild previously accessed Kindergarten or Commonwealth Inclusion Support or similar programReferred by NDIS or Early Childhood Intervention or Preschool Field Officer or MCH nurse or similar
NDIS reference number
Please attach a copy of the assessment or letter

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YesNo
Name of support service / agency*
max 255 characters
If any of the below apply to you, your child, or your family, you may be eligible for additional support to access kindergarten:
- Known to or having ever had contact with Child Protection
- Experiencing family violence
- Have ever had contact with The Orange Door
- Previously accessed Flexible Support Packages
- Referred by a Maternal & Child Health Nurse
- Referred by child and family services
YesNo
Experiencing family violence or has had contact with The Orange DoorKnown to or had contact with Child Protection or in Out-of-Home-CareChild or family previously accessed Flexible Support PackagesReferred by Child Protection, Child and Family services, MCH nurse, Out of Home Care provider
Please attach a copy of relevant documentation

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Please attach a copy of relevant documentation

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P1 eligible?
P2 eligible?
input_PPPC
Pre Prep Priority Cohort
Prior Connection
YesNo
Sibling Details*
YesNo
Sibling Details*
Immunisation
YesNo
YesNo
What date is your child due for their next immunisation?*

DayMonthYear
Please attach your child's immunisation record*

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My child is on a recognised catch-up scheduleMy child has a medical exemptionNone of the above
Please provide a copy of your child's AIR Immunisation Medical Exemption Form that has been lodged by an eligible health practitioner with the Australian Childhood Immunisation Register*

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Please provide your child's AIR Immunisation History Form that shows your child is on a recognised catch-up schedule - temporary for 6months only*

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Under the ‘No Jab, No Play’ legislation, before enrolling a child, early childhood education and care services have to first obtain evidence that the child is up to date with all vaccinations that are due for their age, or that they are able to receive.

An Immunisation History Statement from the Australian Immunisation Register (AIR) is the only form of documentation accepted for the purpose of enrolling in an early childhood education and care service.

After enrolment, parents will need to continue to provide up to date Immunisation History Statements to their child’s early childhood service, if their status changes.

You can get your immunisation history statement straight away by accessing your medicare online account via my.gov.au

You can also call the AIR enquiries line (1800 653 809) and ask them to send your immunisation history statement to you. It can take up to 14 days to arrive in the post.

Please note: Only Immunisation History Statements from the Australian Immunisation Register will be accepted as evidence of immunisation.
Kindergarten Preferences

Funded sessional kindergarten registrations are prioritised based on the Victorian State Government's Kindergarten Guidelines, the child's prior connection and by the age of the child (oldest to youngest) to the service of their first preference
What year would you like your child to commence kindergarten? *
What year would you like your child to commence kindergarten? *
Mapped Care Period*
What program type is this application relevant to?*
You will be able to select your preferred kindergartens and groups once you click "Next" at the bottom of this page.

Please select a minimum of 5 preferences and a maximum of 9 preferences.

Preferences can be listed across one service or multiple services.

Please note: Once "Next" is selected, your information will be saved and you will not be able to return to this page. Please check your information is correct.
You will be able to select your preferred kindergartens and groups once you click "Next" at the bottom of this page.

Please select a minimum of 2 and a maximum of 9 preferences.

Preferences can be listed across one service or multiple services.

Please note: Once "Next" is selected, your information will be saved and you will not be able to return to this page. Please check your information is correct.
You will be able to select your preferred kindergartens and groups once you click "Next" at the bottom of this page.

Please select a minimum of 1 and a maximum of 9 preferences.

Preferences can be listed across one service or multiple services.

Please note: Once "Next" is selected, your information will be saved and you will not be able to return to this page. Please check your information is correct.
I am happy to be considered for an alternative kindergarten/session if the preferences I have provided are full.If the preferences I have provided are full, I do not want to be considered for any alternative kindergarten/session. I understand this will limit my chances of being offered a kindergarten place.
YesNo
I am happy to be considered for an alternative kindergarten/session if the preferences I have provided are full.If the preferences I have provided are full, I do not want to be considered for any alternative kindergarten/session. I understand this will limit my chances of being offered a kindergarten place.
YesNo
Authorisation and Declaration
Privacy and Confidentiality statement

The personal information requested in this application is collected by the Kindergarten Central Registration and Enrolment System (CRES) to facilitate central enrolment and placement in early childhood education and care services within the region. This information will be used by CRES for this main purpose and other related activities, such as supporting children's transition to kindergarten and fee invoicing where applicable. All data will be kept confidential. CRES may share this information with relevant government bodies, council organisations, maternal child health, kindergarten managers and educators, and early years services to support the enrolment process and funding. Additionally, information about a child’s medical and additional needs will assist in their transition to kindergarten. The gathered information may also be used to ensure the fair distribution of available places across all kindergarten programs.
I declare that the information provided in this application is true and correct and I give my permission for CRES to share this information with those listed above.
Yes
Yes
Send Notification?
Yes
Yes
form_name
Offer_Response
Program Type Input
Care Period Input
Yes
YesNo
DNU_Please provide the name and year of attendance of siblings*

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token
- Number of Preferences Required
- Should be Empty:

Loddon Mallee Preschool Association

Child's Details

Parent's Details

Additional information about your child

Prior Connection

Immunisation

Kindergarten Preferences

Authorisation and Declaration